As a society and in Minnesota we do not have a standard definitions of culture, diversity or inequities. These terms and concepts mean different things to different people. Cultural humility was an early addition to the concept of person and family-centered approaches by co-creation groups. These groups wanted culture to be defined.

In these discussions the term “humility” was preferred generally preferred over “competence”. People desired professionals to be competent. However, many were concerned about the misuse of this approach. They did not want any professional to feel they have arrived at competence in knowing others. Cultural humility implied that to be person and family-centered, professionals needed to be humble and willing to learn. Additional feedback from the MinnesotaCultural and Ethnic Communities Leadership Council (CECLC) recommended considering the term “cultural reverence” as yet another frame. Reverence goes beyond tolerance or acceptance to admiration and respect. The CECLC also wanted professionals and systems to understand that professional training will never be enough. The alignment of funding, policy, practice, and measures of success in organizations and systems was even more critical to change.

This content takes an approach that tries to balance these views. In general the content uses the term cultural responsiveness to express these concepts in action. It includes looking at every aspect of individual practice. It is also inclusive of organizational and systemic approaches.

In co-creation discussions people wanted assurance and clarity about what the word “culture” represented. They wanted professionals to think broadly about it. The following is the final definition as developed by these groups. It contains a multidimensional view of the things that influence a person’s beliefs and behavior.

Culture, cultural identity, and worldview are multidimensional. They are influenced by aspects such as the following: (not a complete list)

• language, ethnicity, and heritage;
• spiritual practices and beliefs,
• family and community norms;
• personal attributes such as gender, age, race, abilities, sexual orientation, and gender identity; and
• personal experiences such as others’ responses to personal attributes, economic status, military service, education,
• trauma-experiences, and geography.

Co-creation groups did not deeply discuss the impact of intersecting aspects of inequity. However, this definition of culture implies intersectionality as a critical piece of cultural context. For example, being a person of color, being Muslim, having a mental illness, and being gay are all aspects of identity that are impacted by inequities. However, the impact of the intersection of these different identities in one person may be much greater than any one of these alone. Practitioners must have skills in getting to know people and families as individuals. They need to go beyond what is visible or obvious. They must have skills in understanding what these aspects of identity mean to the person. They must also have a sense of the impact of social and service oriented support or lack of support for these aspects of identity. They must understand the deep threat that many people live under for being themselves.

Many co-creation participants were excited about the emerging definition of cultural humility. The inclusion of the need to recognize structural issues and a commitment to act to change them was powerful to many. However, they cautioned that those actions needed to be lead by people from communities that do not experience equity in mental health treatments and supports.

The inclusion of ongoing learning was important to people. Participants felt it was very easy for those in the system to feel things were good enough. Instead, participants liked the idea of ongoing, lifelong learning and change. They felt this should include self-reflection by individual practitioners. It also needed to include reflection and action around policies, practices, and funding at all levels of the system. Below is the final definition as developed by these groups.

Cultural humility acknowledges that culture influences all things and exerts a powerful force on behaviors and beliefs. It acknowledges that all people, communities, organizations, and systems are cultural carriers whether they are conscious of this or not.

Cultural humility acknowledges that the current human service systems unintentionally but powerfully perpetuate a historical and limited set of cultural norms and patterns of inequity. These norms and patterns include a perspective of people and families in these systems as being separate, broken, and needing to be fixed.

Cultural humility makes a commitment to lifelong learning about self and others. It includes a commitment to equalize power imbalances in our work, systems, and communities. It commits to co-creation of communities where all are included, valued, and represented in power.

Organizations and systems have their own cultures. They often share:

• language and forms of communication (for example: jargon, labels, meetings, brochures, English, etc.)
• beliefs and values (for example: What is mental illness? What causes it? How should we respond? Who is in charge? What is recovery? etc.)
• tools (for example: the forms or computer programs used, the format of plans, policies, hours of operation, location, etc.)
• history (for example, the history of institutionalization, criminalization, community support, recovery, in mental health, etc.)

Because systems and organizations hold power, the people inside them do not often notice or reflect on these aspects. They may not be conscious of how the system may be encouraging the success of some while providing less benefit to others. Reflection on the culture of systems and organizations is needed. Otherwise, unhelpful norms from the past may brought into the present. This is true even when individual practitioners are working to combat them. These norms are expressed silently through unexamined policies, practices and tools. It was exciting to many participants that the “culture” of the service system was openly acknowledged as part of this definition.